Provider Demographics
NPI:1174756845
Name:MARRA, PAUL ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:MARRA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 JONESTOWN RD STE 331
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2983
Mailing Address - Country:US
Mailing Address - Phone:717-671-6903
Mailing Address - Fax:717-671-6903
Practice Address - Street 1:5125 JONESTOWN RD STE 331
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2983
Practice Address - Country:US
Practice Address - Phone:717-671-6903
Practice Address - Fax:717-671-6903
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037859L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist